Miharu Nakanishi1, Yumi Shindo2, Junko Niimura3. 1. Department of Pychiatry and behavioral Sciences, Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan. Electronic address: mnakanishi-tky@umin.ac.jp. 2. Division of Research, Tokyo Dementia Care Research and Training Center, Suginami-ku, Tokyo, Japan. 3. Department of Pychiatry and behavioral Sciences, Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan.
Abstract
OBJECTIVES: Intermediate care for patients with dementia has important implications for aging in place as long as possible. In Japan, geriatric intermediate care facilities provide institutional rehabilitation services to patients under the public Long-Term Care Insurance program and aim to discharge the patients to home from the hospital. The aim of this study was to determine the association between dementia and discharge destination of patients in geriatric intermediate care facilities in Japan. DESIGN: This study was conducted using a retrospective study design for data from 2007, 2010, and 2013. SETTING: We used data from the Survey of Institutions and Establishments for Long-Term Care, which is a nationally representative cross-sectional survey that assessed discharges from geriatric intermediate care facilities in September. PARTICIPANTS: There were 9992 discharged patients included in the analysis. MEASUREMENTS: Discharge destination was categorized as home, facility, hospital, or death. Primary disease was based on ICD-10 codes. Diagnosis of dementia included F00 (Alzheimer), F01 (vascular), F02 (other), and F03 (unspecified). Multilevel multinomial logistic analysis was used for discharge destination, with discharge to home as the reference group. RESULTS: Of the 9992 discharged patients, 2483 (24.8%) had dementia as the primary disease. Of the 2483 patients with dementia, 1090 (43.9%) were hospitalized, 624 (25.1%) were admitted to another facility, 605 (24.4%) were discharged to home, and 164 (6.6%) were discharged by death. Patients with dementia were more likely to be admitted to hospital (adjusted odds ratio [OR] 1.47; 95% confidence interval [CI] 1.25-1.73; P < .001), transferred to another facility (adjusted OR 1.94; 95% CI 1.64-2.29; P < .001), or discharged by death (adjusted OR, 1.46; 95% CI 1.13-1.89; P = .004) than discharged to home. CONCLUSION: Intermediate care in residential settings might have limited effectiveness in discharging patients with dementia to home. The national dementia plan should explore intermediate care for dementia at other care settings rather than facilities.
OBJECTIVES: Intermediate care for patients with dementia has important implications for aging in place as long as possible. In Japan, geriatric intermediate care facilities provide institutional rehabilitation services to patients under the public Long-Term Care Insurance program and aim to discharge the patients to home from the hospital. The aim of this study was to determine the association between dementia and discharge destination of patients in geriatric intermediate care facilities in Japan. DESIGN: This study was conducted using a retrospective study design for data from 2007, 2010, and 2013. SETTING: We used data from the Survey of Institutions and Establishments for Long-Term Care, which is a nationally representative cross-sectional survey that assessed discharges from geriatric intermediate care facilities in September. PARTICIPANTS: There were 9992 discharged patients included in the analysis. MEASUREMENTS: Discharge destination was categorized as home, facility, hospital, or death. Primary disease was based on ICD-10 codes. Diagnosis of dementia included F00 (Alzheimer), F01 (vascular), F02 (other), and F03 (unspecified). Multilevel multinomial logistic analysis was used for discharge destination, with discharge to home as the reference group. RESULTS: Of the 9992 discharged patients, 2483 (24.8%) had dementia as the primary disease. Of the 2483 patients with dementia, 1090 (43.9%) were hospitalized, 624 (25.1%) were admitted to another facility, 605 (24.4%) were discharged to home, and 164 (6.6%) were discharged by death. Patients with dementia were more likely to be admitted to hospital (adjusted odds ratio [OR] 1.47; 95% confidence interval [CI] 1.25-1.73; P < .001), transferred to another facility (adjusted OR 1.94; 95% CI 1.64-2.29; P < .001), or discharged by death (adjusted OR, 1.46; 95% CI 1.13-1.89; P = .004) than discharged to home. CONCLUSION: Intermediate care in residential settings might have limited effectiveness in discharging patients with dementia to home. The national dementia plan should explore intermediate care for dementia at other care settings rather than facilities.
Authors: Bettina M Zimmermann; Insa Koné; Michael Rost; Agnes Leu; Tenzin Wangmo; Bernice S Elger Journal: BMC Health Serv Res Date: 2019-05-08 Impact factor: 2.655